Dr Cheang emphasises the fact that government spending in Singapore is less than 20pc of GDP. By contrast, the ratio frequently exceeds 40pc among OECD countries. It will be over 45pc in the UK this year. According to Dr Cheang, the Singapore government spends £3,500 per person per annum less than the UK Government on social spending, yet achieves better outcomes. Singapore really does have one of the best health systems in the world. Lower government spending allows taxes to be much lower.
Singapore’s approach to healthcare is striking. When it became independent, it inherited the British, i.e. NHS, approach to healthcare. This model was consciously rejected by Singapore’s leader, Lee Kwan Yew, as inherently wasteful. Instead, under the Singapore model, although the state provides a framework for healthcare and ensures that poorer people are properly looked after, the system relies upon individual contributions and obligatory membership of a state-sponsored fund that provides money for healthcare, unemployment pay, education and pensions. Singaporeans wanting to access healthcare services, including visiting a GP, have to pay something towards the costs.
The education system has also been a startling success, with very high levels of attainment. Again, it is a mixture of individual payment and competition with efficient state involvement and state provision of funds to finance the education of under-privileged children.
What I find most remarkable in this whole story is the apparent lack of interest of the British establishment in the success of this extraordinary little country. The “Blob” consistently assumes that if we don’t know best in this country, at least the apparent lessons from abroad don’t apply to us because our circumstances are so different. In the case of Singapore, they can adduce the fact that its population, at under 6m, is less than 10pc of Britain’s and covers an area less than twice the size of the Isle of Wight. But these are excuses for inaction rather than points that substantially explain the shortfall in Britain’s relative achievement.
When it comes to healthcare, anyone who has the temerity to suggest that our NHS is not the envy of the world is immediately lambasted with the accusation they want to turn our system into something like the American one. The unspoken assumption is that this is the only alternative model and no one in their right mind would want our health system to turn out like America’s. Yet there are many other options, of which the Singapore model is one. Health systems in many continental countries also compare very favourably with ours, and they tend to use a mixture of insurance, state provision and co-payment.
For me, though, the really striking thing about Singapore’s achievement is its breadth. Everything from healthcare and social services to education, traffic management, industrial policy and pension provision has been intelligently structured (as you can see from the table below).
